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Anticoagulation Clinic
Home / Medical Services / Anticoagulation Clinic / For Health Care Providers / Warfarin / Management of Elevated INR

Management of Elevated INRs

 

INR Symptoms Recommendations

INR > therapeutic < 5 No significant bleeding Omit a dose

Resume at a lower dose
RTC in 1 week

INR 5-6 No significant bleeding Omit a dose

Consider 500mcg po Vitamin K
(available OTC)
RTC in 1 week

INR 6-9 Consider ER referral if high risk for bleed Omit a dose

Consider 2.5mg po Vitamin K
Check INR daily

INR > 9 Consider ER referral if high risk for bleed Omit a dose
Consider 5mg po Vitamin K
Check INR daily

Any INR Serious or life-threatening bleed ED referral

 

Increase or decrease oral Vitamin K administration based on the clinical situation.

Parenteral Vitamin K should only be used for life-threatening bleeding and is therefore not appropriate
for outpatient use.

Use the recommendations for the next lower INR range in the following situations:

1. High initial INR – First 7 days are rapid suppression of Factor VII 
(the faster the INR goes up, the faster it comes down)
2. High thrombosis risk – First 30 days following venous thromboembolism
 3. Active malignancy
4. Antiphospholipid Antibodies (APLA)
5. Femoral Bypass Graft  

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